IVF Cycle #2: The Trigger

“But I don’t want to go among mad people,” Alice remarked.
“Oh, you can’t help that,” said the Cat: “we’re all mad here. I’m mad. You’re mad.”
“How do you know I’m mad?” said Alice.
“You must be,” said the Cat, “or you wouldn’t have come here.”

— Lewis Carroll, Alice in Wonderland

Yesterday morning we had my favorite nurse again for the monitoring appointment. Debbie was the one who first taught us how to inject my meds way back in September 2014, a few days before we left for England & Wales on what was booked as a ‘we-can’t-have-children’ trip. That all seems so far away now. This time Ross was in the room with us and the day had a full-circle feeling, especially given that it was the three year anniversary of when we transferred him as an embryo.

I’d resigned myself to the idea of having another appointment this morning, taking my trigger shot tonight, and showing up for the egg retrieval early Friday morning, but Debbie was convinced I had the chance of triggering a day early; we just had to wait to see what Dr. K thought. Just in case, she went over all my pre-surgery instructions after my ultrasound before wishing me luck and telling me she hoped she didn’t see us back the next day.

The call didn’t come until late afternoon, but she was right, it was time to trigger! No more stim injections before bed and for the first time in weeks I wouldn’t wake up to stick myself in the stomach with Lupron. This was what we’d been waiting for– and I felt strangely unprepared, now not ready to give up the routine to which I’d become accustomed.

The ultrasound showed that my egg follicles were continuing to grow closer to maturation, and while there is variation in size, the majority seem to be fairly uniform– exactly what this medication protocol was meant to encourage. It doesn’t seem like there are quite as many this time, but I am hoping that any decrease in egg quantity is offset by an increase in quality. It seems like my follicles could use a little more time to progress to the ideal 18-22mm, but unfortunately, my estrogen level has been pushed to the limit. Again, I am at risk of OHSS, or Ovarian Hyper Stimulation Syndrome (which was once described to me as sending shards of glass down your veins and, as a result, leaking fluid through your body). My estrogen level started at 29 and has increased more than 130x to nearly 4,000 (the threshold for when it starts to get worrisome) in about 10 days. I was thankfully able to avoid hyper-stimulation before, and I’m hoping to do that again; however, because I am so close, I was only able to take a half dose of hCG for my trigger shot.

The trigger is what tells my ovaries to finish up the process and prepare my eggs for release. It has to be given at an specific time, which is based on the schedule for my retrieval (36 hours after trigger) so that the doctor can collect them before they’re actually let go. This is the final injection, but it’s also the worst. The needle is much bigger, and Kyle has to administer it (something we both hate) because it goes into my backside. I could give myself injections into my belly all day long, but not having control over this one makes me a little jumpy. We set everything up and, because I am nothing if not a rule-follower, waited until the clock turned to exactly 8:30pm to inject.

Everything we need to triggerThere it is: the very last one.

Kyle was far more nervous than I was, mumbling to himself as he picked up the syringe. I briefly considering screaming when he made contact just to mess with him but decided against it because I didn’t want him to accidentally stab me again, this time in the wrong place. (He didn’t think this was very funny and appreciated my restraint, but I can’t help but feel that the same would have crossed his mind if our positions were reversed.) The injection was painfully slow and I could feel every bit of it, but it was all over in less than 30 seconds. Just like that— we were done. I could get two lines on any home pregnancy test I want… but only because of the synthetic hCG in my system.

There is now nothing more I can do to contribute to the success of this cycle beyond taking my last antibiotic before bed and rinsing off all of my lotion and products tomorrow morning (embryos don’t like anything scented). Part of me feels anxious that it’s basically over– I don’t like the part where we are forced to just wait for the results; I want to be doing something, anything. On the other hand, my ovaries are swollen and uncomfortable now as they are pressing on the scar tissue in my abdomen, and I am ready for my emotions to go back to a more normal range. Weirdly, my left ovary (or the one I referred to earlier as the “problem child”) seems to have produced noticeably more follicles than the right, as evidenced by the fact that my stomach is somewhat lopsided with one side pushed out further than the other. It looks so bizarre and does not feel nice.

All that’s left now is to stop eating or drinking after midnight (which means I’ll be ridiculously thirsty as of 12:05am) and leave super early in the morning to get there for the pre-op. This time tomorrow it will be done, and we will have an egg count.